Examining Urban American Indian Youth's Drug Resistance Skills: Pilot Results from a Culturally Adapted Prevention Program

Living in Two Worlds, an adapted prevention curriculum specifically designed for urban American Indian (UAI) youth, is based on keepin' it REAL, a SAMHSA model program. The systematic adaptation of keepin' it REAL employed elements of UAI cultural heritage to teach the four drug resistance strategies (Refuse, Explain, Avoid, Leave [R-E-A-L]) in culturally appropriate ways that reflected the social context of substance offers to UAI youth. Based on pilot data, changes in the number and type of drug resistance strategies used by UAI are presented. Data come from 57 UAI students at four schools in a large southwestern city. Using a pre/posttest design, the number of times R-E-A-L strategies were used in the last 30 days was assessed as well alternative strategies commonly reported by UAI youth (change the subject; joking/humor). Tests of mean differences from pretest to posttest showed significant increases in the frequency of their use as well as an expanding R-E-A-L repertoire (the # of different R-E-A-L strategies used increased on average by 1.3, SE=0.6). Examining specific R-E-A-L strategies by substance, the largest significant increases were for relatively assertive strategies (Explain, Refuse, Leave). By contrast, more passive strategies showed non-significant small increases (Change subject, Joking) or decreases (Avoid) in mean frequency of use. The adapted curriculum showed promising results of effectiveness in expanding UAI youth's repertoire of drug resistance skills by teaching a range of strategies based on clear communication strategies that fit the social and cultural context in which the students confront opportunities to use substances.